0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Obsessive-Compulsive Disorder and Bulimia
GIOVANNI A. FAVA, M.D.; ANNA RITA RAFFI, M.D.
Am J Psychiatry 2001;158:503-503. doi:10.1176/appi.ajp.158.3.503

To the Editor: Kristin M. von Ranson, Ph.D., and colleagues (1) found higher obsessive-compulsive disorder (OCD) scores in patients who had recovered from bulimia than in a normal comparison group. They suggested the possibility that these behaviors are trait related, since they did not change dramatically with treatment. They neglected to consider, however, an alternative explanation: "the rollback phenomenon." As an illness remits, it progressively recapitulates (although in reverse order) many of the stages and symptoms that were seen during the time it developed (2). The rollback phenomenon has been substantiated in mood disorders (3) and anxiety disorders (4). There is some preliminary evidence that may introduce this possibility also in bulimia nervosa.

A standardized semistructured research interview for eliciting prodromal symptoms (3, 4) was administered to 30 recovered patients with bulimia nervosa (5). Most of the patients reported prodromal symptoms concerned with anxiety, depression, and irritability. Five of the 30 patients reported obsessive-compulsive symptoms according to a specified threshold. The study group included only patients who did not have comorbid axis I DSM-IV disorders. It is conceivable that the number of patients with obsessive-compulsive symptoms could have been higher in a more heterogeneous group. We postulated that the combination of subclinical affective symptoms and stressful life events may create an allostatic load prompting precipitation of bulimia nervosa. Risk factors, such as repeated exposure to negative comments about shape, weight, and eating, may further increase the vulnerability to this allostatic load, resulting in a chronic dissatisfaction with body image and an obsessive preoccupation with food (5). Prodromal symptoms may persist as residual symptoms while the most typical symptom profile abates (3, 4).

The state-trait dichotomy is largely inadequate in clinical settings: psychological constructs conceived as trait dimensions may display sensitivity to change in a specific clinical situation, whereas constructs viewed as state dimensions—because of the rollback phenomenon—may display unexpected stability throughout the longitudinal development of the disorder (6).

Unlike characterological traits, residual symptoms are amenable to treatment, particularly according to a sequential model. This may result in therapeutic efforts of more enduring quality than current strategies (3, 4).

von Ranson KM, Kaye WH, Weltzin TE, Rao R, Matsunaga H: Obsessive-compulsive disorder symptoms before and after recovery from bulimia nervosa. Am J Psychiatry 1999; 156:1703–  1708
 
Detre TP, Jarecki H: Modern Psychiatric Treatment. Philadelphia, Lippincott, 1971
 
Fava GA: Subclinical symptoms in mood disorders. Psychol Med  1999; 29:47–61
[PubMed]
 
Fava GA, Mangelli L: Subclinical symptoms in panic disorder. Psychother Psychosom  1999; 68:281–289
[PubMed]
[CrossRef]
 
Raffi AR, Rondini M, Grandi S, Fava GA: Life events and prodromal symptoms in bulimia nervosa. Psychol Med  2000; 30:727–731
[PubMed]
[CrossRef]
 
Rafanelli C, Park SK, Ruini C, Ottolini F, Cazzaro M, Fava GA: Rating well-being and distress. Stress Med  2000; 16:55–61
[CrossRef]
 
+

References

von Ranson KM, Kaye WH, Weltzin TE, Rao R, Matsunaga H: Obsessive-compulsive disorder symptoms before and after recovery from bulimia nervosa. Am J Psychiatry 1999; 156:1703–  1708
 
Detre TP, Jarecki H: Modern Psychiatric Treatment. Philadelphia, Lippincott, 1971
 
Fava GA: Subclinical symptoms in mood disorders. Psychol Med  1999; 29:47–61
[PubMed]
 
Fava GA, Mangelli L: Subclinical symptoms in panic disorder. Psychother Psychosom  1999; 68:281–289
[PubMed]
[CrossRef]
 
Raffi AR, Rondini M, Grandi S, Fava GA: Life events and prodromal symptoms in bulimia nervosa. Psychol Med  2000; 30:727–731
[PubMed]
[CrossRef]
 
Rafanelli C, Park SK, Ruini C, Ottolini F, Cazzaro M, Fava GA: Rating well-being and distress. Stress Med  2000; 16:55–61
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 18.  >
Textbook of Psychotherapeutic Treatments > Chapter 8.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 59.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 13.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 16.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles